Journal article
Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration
Journal of critical care, Vol.49, pp.64-69
02/2019
DOI: 10.1016/j.jcrc.2018.10.013
PMID: 30388490
Abstract
To evaluate mortality, length of stay, and inter-hospital transfer in the Veteran Health Administration (VHA) among low complexity Intensive Care Unit (ICU) patients.
Retrospective study of adult ICU admissions identified in VHA Medical SAS®; 2010–2015 at Veterans Affairs (VA) Medical Centers. Facilities classified by the Rural Urban Commuting Area code algorithm as large rural (referred to as rural) (N = 6) or urban (N = 33).
In rural hospitals, patients (N = 9665) were less likely to have a respiratory (12.9% v. 18.9%; p < .001) diagnosis, more likely diagnosed with sepsis (17.6% v. 4.9%), and had a higher illness severity score (42.0 vs. 41.4; p = .01) compared to urban (N = 65,846) counterparts. Mortality within ICU did not vary across facility rurality. In unadjusted analyses, facility rurality (rural vs. urban) was associated with reduced inter-hospital transfers (OR = 0.74; 95% CI = [0.69, 0.80]; p < .001) and a shorter ICU length of stay (RR = 0.82; 95% CI = [0.74, 0.91]; p < .001). This did not hold when the hierarchical data was accounted for.
Despite challenges, low complexity ICUs in rural VA facilities fare similarly to urban counterparts. Being part of a national healthcare system may have benefits to explore in sustaining critical care access in rural areas outside the VA healthcare system.
•Patients at rural VA hospitals were less likely to have a respiratory diagnosis.•Mortality, length of stay, and transfers did not differ based on facility rurality.•Inter-hospital transfer more likely when patient had cardiovascular diagnosis.•Proper accounting of hierarchical data is necessary.
Details
- Title: Subtitle
- Outcomes comparison in patients admitted to low complexity rural and urban intensive care units in the Veterans Health Administration
- Creators
- Amy M.J O'Shea - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USASpyridon Fortis - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USAMary Vaughan Sarrazin - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USAJane Moeckli - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USAW.C Yarbrough - Department Pulmonary/Critical Care, VA North Texas Healthcare System, Dallas, TX, USAHeather Schacht Reisinger - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 W, Iowa City, IA 52246, USA
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.49, pp.64-69
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.jcrc.2018.10.013
- PMID
- 30388490
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Grant note
- DOI: 10.13039/100000738, name: Department of Veterans Affairs;; DOI: 10.13039/100007217, name: Veterans Health Administration; DOI: 10.13039/100006379, name: Office of Research and Development; DOI: 10.13039/100007217, name: Health Services Research and Development, award: IIR 09-0336; name: the Veteran Rural Health Center - Central Region [6140
- Language
- English
- Date published
- 02/2019
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Health Management and Policy; Center for Social Science Innovation; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063128502771
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